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1.
Psychiatr Psychol Law ; 30(3): 249-270, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37346060

RESUMO

There is an over-representation of Aboriginal/Indigenous people in the criminal justice systems of Australia, Canada, New Zealand and the United States, with offences committed by male and female Aboriginal prisoners predominantly involving physical violence against a person. Risk assessment tools used have not been developed for Aboriginal people, and validations have produced varied results. The current study focused on violent offenders and investigated the differences between four demographic groups - Aboriginal females (AF), non-Aboriginal females (NAF), Aboriginal males (AM) and non-Aboriginal males (NAM) - on the Level of Service/Risk, Need, Responsivity (LS/RNR) and Violence Risk Scale (VRS; including Screening Version, VRS-SV). Significant differences were evident between all groups; however, there were limited differences between AF and NAF with differences on the VRS-SV primarily due to static factors. Aboriginality did not appear to elevate risk for violent females. The limitations of the study are discussed plus the recommendations for future research.

2.
Psychiatr Psychol Law ; 30(2): 192-210, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36950191

RESUMO

Female offender risk assessment is predominantly based on criminogenic factors that predict reoffending in males. Research indicates there are criminogenic factors specific to female offenders, and certain factors linked to offending for both sexes have greater impact on female offenders. This paper extends current research using a Western Australian sample to determine whether findings are replicated with an Australian cohort. Gender differences in the criminogenic profile of 1704 violent offenders (9% female), assessed using the Level of Service/Risk, Need, Responsivity (LS/RNR) and Violence Risk Scale (VRS), were analysed using a matched sample study design. There were significant gender differences on all components of the LS/RNR, except criminal history. In the subsequent matched study, these differences varied, and females scored significantly lower on all VRS-SV items, except age. Gender differences in violence risk scores were clear, providing support for gender-responsive assessment and treatment of violent female offenders, with further validation needed.

3.
Crim Behav Ment Health ; 31(4): 231-247, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34142389

RESUMO

BACKGROUND: Trajectory analysis has been used to study long-term offending patterns and identify offender subgroups, but few such studies have included people with psychotic disorders (PDs) and these have been restricted to adult offenders. AIMS: To compare offending trajectories among 10-26-year-olds with PDs with those with other mental disorders (OMDs) or none (NMD) and identify associated risk factors. METHODS: This is a record-linkage study of 184,147 people born in Western Australia (WA) 1983-1991, drawing on data from WA mental health information system, WA corrective services and other state-wide registers. Group-based trajectory modelling was used to identify offending trajectories. RESULTS: Four offender groups were identified in each mental health status group: G1-no/negligible offending; G2-early onset, adolescent, desisting by age 18; G3-early onset, low rate, offending into early adulthood; and G4-very early onset, high rate, peaking at age 17, continuing into early adulthood. The PDs group had the lowest proportion of individuals with no or negligible offending histories-84% compared with 88.5% in the OMDs group and 96.6% in the no mental disorder group. Within mental health status offender groups, the PDs group was characterised by early or very early onset offending persisting into adulthood, accounting for 5.4% and 3.7% of the group respectively (OMD: 3.8%, 1.5%; NMD: 1.0%, 0.5%). Gender, indigenous status, substance use problems, childhood abuse and parental offending were generally associated with trajectory group membership, although among those with PDs childhood abuse and parental offending were only significant in the early onset-life-course-persistent group. CONCLUSIONS: While most people with PDs never offend, some are disproportionately vulnerable from a particularly early age. If the offending subgroup is to be helped away from criminal justice involvement, interventions must be considered in childhood.


Assuntos
Criminosos , Transtornos Mentais , Transtornos Psicóticos , Adolescente , Adulto , Criança , Estudos de Coortes , Direito Penal , Humanos , Transtornos Mentais/epidemiologia , Transtornos Psicóticos/epidemiologia
4.
Int J Offender Ther Comp Criminol ; 65(15): 1653-1675, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33131356

RESUMO

Law and ethics require that risk assessment should be cross-culturally valid and fair, but Australian research in this regard is underdeveloped. A logical first step in progressing the work required to build a strong evidence base on culturally sensitive risk assessment in Australia is to determine the expert views of those in the field. We interviewed 13 Australian evaluators who assess Indigenous sexual offenders' recidivism risk to determine their perceptions of the risk assessment instruments they use and the attributes they believe evaluators doing cross-cultural assessments should have. Our central findings are that evaluators use the available instruments because they believe that the same factors predict sexual recidivism for Indigenous and non-Indigenous offenders, but that they do so cautiously knowing the limitations of the instruments. Evaluators nevertheless want more research data to guide them when they use the available instruments to assess people from cultures that differ from those of people in the normative sample. Participants acknowledge that the unique challenges of assessing Indigenous sexual offenders require non-Indigenous evaluators to be culturally competent and confident. These findings should be valuable to evaluators and those who train or supervise evaluators and/or intend to establish or improve the validity of risk instruments in Australia.


Assuntos
Criminosos , Reincidência , Delitos Sexuais , Austrália , Humanos , Medição de Risco
5.
Fam Syst Health ; 38(4): 369-379, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33119369

RESUMO

INTRODUCTION: The current study aimed to assess perinatal depression (PD) screening and treatment practices of obstetrical health care providers. METHOD: Retrospective record reviews (n = 557) evaluated the PD screening, referral, and treatment practices at an Obstetrician/Gynecology practice. This study assessed the frequency of screening for PD, rates of elevated Edinburgh Postnatal Depression Scale (EPDS) scores, treatment recommendations, demographic correlates, and predictors of elevated EPDS scores. RESULTS: PD screening completion rates were: 60.1% (intake), 35% (glucola test), and 85.5% (6-week follow-up). Rates of clinically elevated EPDS scores were: 18.21% (intake), 17.43% (glucola test), and 13.00% (6-week follow-up). Correlates of clinically elevated EPDS scores at intake and 6-week follow-up were history of depression, history of anxiety, and young age. History of depression and anxiety were associated with an increased likelihood of having a clinically significant EPDS score at intake. Intake EPDS score and history of depression were associated with an increased likelihood of having a clinically significant EPDS score at 6-week follow-up. DISCUSSION: Obstetric/gynecology providers should screen for perinatal depression at every obstetrical appointment. It is important to thoroughly assess history of depression and anxiety. Education and training for health care providers and perinatal women may improve the mental health experience of perinatal women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Depressão/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Assistência Perinatal/métodos , Adolescente , Adulto , Depressão/fisiopatologia , Depressão/psicologia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Obstetrícia/tendências , Assistência Perinatal/tendências , Escalas de Graduação Psiquiátrica , Psicometria/instrumentação , Psicometria/métodos , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários
6.
Psychiatry Res ; 291: 113161, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32562932

RESUMO

The prevalence and negative effects of perinatal depression are well known. The Edinburgh Postnatal Depression Scale (EPDS) is a common screening tool for perinatal depression and it is recommended for use by several professional organizations. The current study tested competing EPDS factor structures and assessed EPDS change from intake to 6-week follow-up, and identified demographic correlates in an outpatient obstetric sample. Using a retrospective observational study design, medical records were coded for demographic, mental health, and EPDS patient data (n = 524). Confirmatory factor analysis, t-tests, and ANOVA were utilized. Findings included: (1) a 3-factor model (i.e. anxiety, depression, anhedonia) of the EPDS displayed the best fit to the current data; (2) small declines in all 3 subscales of the EPDS from intake to 6-week follow-up appointments and; (3) demographic correlates of EPDS subscales included history of depression, history of anxiety, race, and pregnancy status (i.e. first child or not). The 3-factor structure can be used in clinical practice to assess perinatal depression in a nuanced fashion. Given that history of depression and anxiety are risk factors for perinatal depression, a thorough assessment of these items in clinical practice is needed.


Assuntos
Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/psicologia , Vigilância da População , Escalas de Graduação Psiquiátrica/normas , Psicometria/normas , Adulto , Feminino , Seguimentos , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Gravidez , Psicometria/métodos , Estudos Retrospectivos , Fatores de Risco
7.
Soc Psychiatry Psychiatr Epidemiol ; 55(4): 517-525, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31324961

RESUMO

PURPOSE: To examine the impact of substance use and other risk factors on conviction rates in people with a psychotic illness (PI) and other mental disorders (OMD) compared to those with no mental illness (NMI). METHODS: This research is part of a longitudinal record-linked whole-population study of 467,945 children born in Western Australia (WA) between 1980 and 2001. This cohort was identified through linkages between the WA psychiatric case register, WA corrective services data and other state-wide registers. We assessed 184,147 individuals born during 1983-1991 to explore the impact of exposure to a variety of risk factors on conviction rates. RESULTS: People with PI and OMD had higher conviction rates than those with NMI, with unadjusted incidence rate ratios (IRR) of 3.98 (95% CI 3.67-4.32) for PI and 3.18 (95% CI 3.03-3.34) for OMD. Adjusting for substance use reduced the rates by 60% in PI and 30% in OMD: IRRs 1.59 (95% CI 1.45-1.74) and 2.24 (2.12-2.37), respectively. Minimal change was seen when adjusting for other potential risk factors (including socio-demographics, victimisation and parental offending), with adjusted IRRs 1.58 (95% CI 1.43-1.74) for PI and 1.90 (95% CI 1.80-2.02) for OMD. CONCLUSIONS: Our analysis shows people with a mental illness have higher rates of conviction than those with NMI. Substance use has a major impact on this rate. Results suggest the need for a greater investment in programs addressing the issue of comorbid substance use with a view to reduce the rate of convictions in this population.


Assuntos
Crime/estatística & dados numéricos , Criminosos/psicologia , Transtornos Mentais/epidemiologia , Transtornos Psicóticos/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Criança , Estudos de Coortes , Comorbidade , Crime/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/psicologia , Transtornos Psicóticos/psicologia , Sistema de Registros , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/psicologia , Austrália Ocidental/epidemiologia , Adulto Jovem
8.
Ecol Appl ; 28(3): 749-760, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29509310

RESUMO

The biodiversity and high productivity of coastal terrestrial and aquatic habitats are the foundation for important benefits to human societies around the world. These globally distributed habitats need frequent and broad systematic assessments, but field surveys only cover a small fraction of these areas. Satellite-based sensors can repeatedly record the visible and near-infrared reflectance spectra that contain the absorption, scattering, and fluorescence signatures of functional phytoplankton groups, colored dissolved matter, and particulate matter near the surface ocean, and of biologically structured habitats (floating and emergent vegetation, benthic habitats like coral, seagrass, and algae). These measures can be incorporated into Essential Biodiversity Variables (EBVs), including the distribution, abundance, and traits of groups of species populations, and used to evaluate habitat fragmentation. However, current and planned satellites are not designed to observe the EBVs that change rapidly with extreme tides, salinity, temperatures, storms, pollution, or physical habitat destruction over scales relevant to human activity. Making these observations requires a new generation of satellite sensors able to sample with these combined characteristics: (1) spatial resolution on the order of 30 to 100-m pixels or smaller; (2) spectral resolution on the order of 5 nm in the visible and 10 nm in the short-wave infrared spectrum (or at least two or more bands at 1,030, 1,240, 1,630, 2,125, and/or 2,260 nm) for atmospheric correction and aquatic and vegetation assessments; (3) radiometric quality with signal to noise ratios (SNR) above 800 (relative to signal levels typical of the open ocean), 14-bit digitization, absolute radiometric calibration <2%, relative calibration of 0.2%, polarization sensitivity <1%, high radiometric stability and linearity, and operations designed to minimize sunglint; and (4) temporal resolution of hours to days. We refer to these combined specifications as H4 imaging. Enabling H4 imaging is vital for the conservation and management of global biodiversity and ecosystem services, including food provisioning and water security. An agile satellite in a 3-d repeat low-Earth orbit could sample 30-km swath images of several hundred coastal habitats daily. Nine H4 satellites would provide weekly coverage of global coastal zones. Such satellite constellations are now feasible and are used in various applications.


Assuntos
Biodiversidade , Tecnologia de Sensoriamento Remoto/instrumentação , Oceanos e Mares , Fitoplâncton
9.
Aust N Z J Psychiatry ; 51(10): 1032-1040, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28093927

RESUMO

OBJECTIVE: Children of parents with severe mental illness have an increased risk of offending. Studies suggest that risk factors such as parental offending and social disadvantage may be associated with the increased risk. This paper assesses the impact of these risk factors on offending rates in the offspring of women with severe mental illness compared to offspring of unaffected women. METHODS: This is part of a longitudinal record-linked whole-population study of 467,945 children born in Western Australia from 1980 to 2001 to mothers with severe mental illness and mothers with no recorded psychiatric illness. These data were linked to Western Australia corrective services data producing a dataset of 12,999 people with at least one offence (3.7% of birth cohort). Cox proportional hazard was used to calculate incidence rate ratios of offspring offending. RESULTS: The offending rate for offspring of mothers with severe mental illness (cases) was almost three times the rate for offspring of unaffected mothers (comparison) with an unadjusted incidence rate ratio of 2.75 (95% confidence interval: [2.58, 2.93]). Adjusting for sex, indigenous status, socio-economic status and geographical remoteness reduced the rate ratio by 24% to incidence rate ratio 2.10, 95% confidence interval: [1.97, 2.23]. Adjusting for parental offending further reduced the rate ratio by 23% to incidence rate ratio 1.62, 95% confidence interval: [1.52, 1.72]. The mean age at first recorded offence was significantly lower for cases compared to comparison offspring. CONCLUSION: Children of mothers with a severe mental illness have a higher rate of offending than children of unaffected mothers, and social disadvantage and parental offending have a major impact on this rate. Services supporting these vulnerable children need to focus on improving the social environment in which they and their families live in.


Assuntos
Filho de Pais com Deficiência/estatística & dados numéricos , Criminosos/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Mães/estatística & dados numéricos , Fatores Socioeconômicos , Populações Vulneráveis/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Austrália Ocidental/epidemiologia , Adulto Jovem
10.
Soc Psychiatry Psychiatr Epidemiol ; 51(2): 269-79, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26581211

RESUMO

PURPOSE: Our aim was to establish the 12-month prevalence of violent victimisation in a large sample of adults with psychotic disorders (N = 1825), compare this to population estimates, and examine correlates of violent victimisation. METHODS: The Australian national psychosis survey used a two-phase design to draw a representative sample of adults aged 18-64 years with psychotic disorders. Interview questions included psychopathology, cognition, sociodemographics, substance use, criminality, and childhood and adult victimisation. Multivariable logistic regression models were used to examine the independent contributions of known risk factors, clinical profile and childhood abuse, on risk of violent victimisation. Differences between men and women were examined. RESULTS: Among adults with psychotic disorders, 12-month prevalence of any victimisation was 38.6% (males 37.4%, females 40.5%), and of violent victimisation was 16.4% (males 15.2%; females 18.3%). Violent victimisation was 4.8 times higher than the population rate of 3.4% (6.5 times higher for women; 3.7 times higher for men). Significant correlates of violent victimisation were established sociodemographic and behavioural risk factors predicting victimisation in the general community: younger age, residence in the most disadvantaged neighbourhoods, homelessness, lifetime alcohol abuse/dependence, and prior criminal offending. Among clinical variables, only mania and self-harm remained significant in the multivariable model. Childhood abuse was independently associated with violent victimisation. CONCLUSIONS: Rates of violent victimisation are high for people with psychotic disorders, especially women, compared to population rates. Greater exposure to sociodemographic and behavioural risks may render them particularly vulnerable to victimisation. Social cognition as a valuable treatment target is discussed.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/estatística & dados numéricos , Vítimas de Crime/estatística & dados numéricos , Transtornos Psicóticos/epidemiologia , Violência/estatística & dados numéricos , Adolescente , Adulto , Austrália/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores de Risco , Distribuição por Sexo , Inquéritos e Questionários , Adulto Jovem
11.
Bioinformatics ; 30(2): 292-4, 2014 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-24273241

RESUMO

UNLABELLED: Pathway Commons is a resource permitting simultaneous queries of multiple pathway databases. However, there is no standard mechanism for using these data (stored in BioPAX format) to annotate and build quantitative mathematical models. Therefore, we developed a new module within the virtual cell modeling and simulation software. It provides pathway data retrieval and visualization and enables automatic creation of executable network models directly from qualitative connections between pathway nodes. AVAILABILITY AND IMPLEMENTATION: Available at Virtual Cell (http://vcell.org/). Application runs on all major platforms and does not require registration for use on the user's computer. Tutorials and video are available at user guide page.


Assuntos
Fenômenos Fisiológicos Celulares , Bases de Dados Factuais , Redes Reguladoras de Genes , Modelos Teóricos , Transdução de Sinais , Software , Biologia Computacional , Armazenamento e Recuperação da Informação
12.
Artigo em Inglês | MEDLINE | ID: mdl-22139996

RESUMO

The Virtual Cell (VCell) is a general computational framework for modeling physicochemical and electrophysiological processes in living cells. Developed by the National Resource for Cell Analysis and Modeling at the University of Connecticut Health Center, it provides automated tools for simulating a wide range of cellular phenomena in space and time, both deterministically and stochastically. These computational tools allow one to couple electrophysiology and reaction kinetics with transport mechanisms, such as diffusion and directed transport, and map them onto spatial domains of various shapes, including irregular three-dimensional geometries derived from experimental images. In this article, we review new robust computational tools recently deployed in VCell for treating spatially resolved models.


Assuntos
Modelos Biológicos , Membrana Celular/química , Biologia Computacional , Simulação por Computador , Software , Interface Usuário-Computador
13.
Ground Water ; 49(2): 250-69, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-20180865

RESUMO

Hydrogeophysical methods are presented that support the siting and monitoring of aquifer storage and recovery (ASR) systems. These methods are presented as numerical simulations in the context of a proposed ASR experiment in Kuwait, although the techniques are applicable to numerous ASR projects. Bulk geophysical properties are calculated directly from ASR flow and solute transport simulations using standard petrophysical relationships and are used to simulate the dynamic geophysical response to ASR. This strategy provides a quantitative framework for determining site-specific geophysical methods and data acquisition geometries that can provide the most useful information about the ASR implementation. An axisymmetric, coupled fluid flow and solute transport model simulates injection, storage, and withdrawal of fresh water (salinity ∼500 ppm) into the Dammam aquifer, a tertiary carbonate formation with native salinity approximately 6000 ppm. Sensitivity of the flow simulations to the correlation length of aquifer heterogeneity, aquifer dispersivity, and hydraulic permeability of the confining layer are investigated. The geophysical response using electrical resistivity, time-domain electromagnetic (TEM), and seismic methods is computed at regular intervals during the ASR simulation to investigate the sensitivity of these different techniques to changes in subsurface properties. For the electrical and electromagnetic methods, fluid electric conductivity is derived from the modeled salinity and is combined with an assumed porosity model to compute a bulk electrical resistivity structure. The seismic response is computed from the porosity model and changes in effective stress due to fluid pressure variations during injection/recovery, while changes in fluid properties are introduced through Gassmann fluid substitution.


Assuntos
Monitoramento Ambiental/métodos , Movimentos da Água , Abastecimento de Água/análise
14.
Biophys J ; 95(4): 1795-812, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18487300

RESUMO

A 3D model was developed and used to explore dynamics of phosphatidylinositol-4,5-bisphosphate (PIP2) signaling in cerebellar Purkinje neurons. Long-term depression in Purkinje neurons depends on coincidence detection of climbing fiber stimulus evoking extracellular calcium flux into the cell and parallel fiber stimulus evoking inositol-1,4,5-trisphosphate (IP3)-meditated calcium release from the endoplasmic reticulum. Experimental evidence shows that large concentrations of IP3 are required for calcium release. This study uses computational analysis to explore how the Purkinje cell provides sufficient PIP2 to produce large amounts of IP3. Results indicate that baseline PIP2 concentration levels in the plasma membrane are inadequate, even if the model allows for PIP2 replenishment by lateral diffusion from neighboring dendrite membrane. Lateral diffusion analysis indicates apparent anomalous diffusion of PIP2 in the spiny dendrite membrane, due to restricted diffusion through spine necks. Stimulated PIP2 synthesis and elevated spine PIP2 mediated by a local sequestering protein were explored as candidate mechanisms to supply sufficient PIP2. Stimulated synthesis can indeed lead to high IP3 amplitude of long duration; local sequestration produces high IP3 amplitude, but of short duration. Simulation results indicate that local sequestration could explain the experimentally observed finely tuned timing between parallel fiber and climbing fiber activation.


Assuntos
Cerebelo/metabolismo , Cerebelo/ultraestrutura , Dendritos/metabolismo , Modelos Neurológicos , Fosfatidilinositol 4,5-Difosfato/metabolismo , Células de Purkinje/metabolismo , Transdução de Sinais/fisiologia , Transmissão Sináptica/fisiologia , Simulação por Computador
15.
Diabetes Educ ; 32(5): 714-20, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16971705

RESUMO

PURPOSE: This article describes a pilot project to improve knowledge, attitudes, and skills of ad hoc interpreters working with Native American diabetes patients with limited English proficiency. METHODS: Case-based studies reflecting clinical situations were developed. Key concepts and terms from the cases were translated into the Navajo language and carefully back translated using the newly standardized Navajo diabetes terminology. Twenty-two health care workers from 2 Indian Health Service facilities were recruited for a pilot study to compare the performance of interpreters trained in a formal workshop using the case studies with that of interpreters who independently reviewed a video made from the training. RESULTS: Workshop participants noted significant improvements in their knowledge and comfort level in interpretation of diabetes concepts but not about unrelated topics; the independent study group perceived less improvement. CONCLUSION: Formal training for interpreters working with diabetes patients should be considered by diabetes educators working in settings where medical interpreters are needed. Diabetes educators should encourage back translation of key diabetes concepts to understand exactly what is being said to patients. Those working with multiple interpreters should make sure there are opportunities for interpreters to discuss translations of key concepts with each other and the educators so that translations are accurate and consistent among interpreters. Independent study did not appear to be an effective way to improve the ability of interpreters to translate current diabetes concepts accurately.


Assuntos
Diversidade Cultural , Diabetes Mellitus/reabilitação , Idioma , Educação de Pacientes como Assunto/métodos , Currículo , Humanos , Projetos Piloto
17.
Obstet Gynecol ; 105(5 Pt 2): 1203-5, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15863582

RESUMO

BACKGROUND: Methotrexate and misoprostol are frequently used in combination for medical termination of pregnancy. Despite their frequent use, published information about low-dose exposures to these known teratogens is sparse and neonatal follow-up data are limited. We present neonatal outcomes in three infants from two different women who had failed medical terminations with methotrexate and misoprostol. CASES: A young gravida 1, para 0, presented with intrauterine pregnancy complicated by first-trimester exposure to oral methotrexate and vaginal misoprostol. Ultrasonography determined that the fetus had intrauterine growth restriction and ventriculomegaly. The infant had growth and developmental delays. A young gravida 4, para 3-0-0-3, also presented after first trimester exposure to methotrexate and misoprostol, and was found to have a twin gestation. The infants were noted to have multiple congenital anomalies, growth restriction, and developmental delay. CONCLUSION: Even single doses of methotrexate and misoprostol used in medical termination of pregnancy can be associated with multiple congenital anomalies.


Assuntos
Anormalidades Congênitas/etiologia , Deficiências do Desenvolvimento/etiologia , Feto/anormalidades , Metotrexato/efeitos adversos , Misoprostol/efeitos adversos , Resultado da Gravidez , Aborto Incompleto , Aborto Induzido/efeitos adversos , Aborto Induzido/métodos , Adulto , Anormalidades Congênitas/diagnóstico por imagem , Deficiências do Desenvolvimento/fisiopatologia , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Metotrexato/uso terapêutico , Misoprostol/uso terapêutico , Gravidez , Medição de Risco , Ultrassonografia Pré-Natal
18.
Ethn Dis ; 15(2): 300-4, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15825977

RESUMO

This report is based on the experiences of Navajo interpreters working in a diabetes clinical trial and describes the problems encountered in translating the standard research consent across cultural and linguistic barriers. The interpreters and a Navajo language consultant developed a translation of the standard consent form, maintaining the sequence of information and exactly translating English words and phrases. After four months of using the translated consent, the interpreters met with the language expert and a diabetes expert to review their experiences in presenting the translation in the initial phases of recruitment. Their experiences suggest that the consent process often leads to embarrassment, confusion, and misperceptions that promoted mistrust. The formal processes that have been mandated to protect human subjects may create barriers to research in cross-cultural settings and may discourage participation unless sufficient attention is given to ensuring that both translations and cross-cultural communications are effective.


Assuntos
Barreiras de Comunicação , Termos de Consentimento , Indígenas Norte-Americanos/psicologia , Consentimento Livre e Esclarecido/psicologia , Idioma , Multilinguismo , Relações Pesquisador-Sujeito , Adulto , Idoso , Diabetes Mellitus Tipo 2/etnologia , Humanos , Pessoa de Meia-Idade , New Mexico , Educação de Pacientes como Assunto/métodos , Sujeitos da Pesquisa/psicologia , Semântica , Tradução , Estados Unidos , United States Indian Health Service
19.
Artigo em Inglês | MEDLINE | ID: mdl-12955629

RESUMO

Despite increasing prevalence of asthma among American Indians and/or Alaska Natives, little is known about their use of traditional healing in its management. A convenience sample of 24 Navajo families with asthmatic members (n=35) was interviewed between June 1997 and September 1998. While 46% of families had previously used traditional healing, only 29% sought traditional healing for asthma. Use of traditional healing was unrelated to use of biomedical therapies, hospitalizations, or emergency services. Practical factors and questions about the nature and origins of asthma were the primary considerations determining use of traditional medicine. Little conflict between traditional healing and biomedical treatment was reported. The use of traditional healing for asthma is influenced by beliefs about the disease and factors specific to the individual, including their local social, economic, and cultural context.


Assuntos
Asma/terapia , Indígenas Norte-Americanos , Medicina Tradicional , Adolescente , Adulto , Asma/tratamento farmacológico , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico , Filosofia Médica , Pesquisa Qualitativa , Terapias Espirituais
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